关键词: 椎间盘突出, 椎间盘移位, 经皮椎间孔镜, 焦虑, 抑郁, 预后

Abstract: Background　Percutaneous transforaminal endoscopic spine surgery has gradually become one of the common surgical procedures for the treatment of lumbar disc herniation（LDH）．However，few studies have been conducted to analyze the incidence of adverse psychological state before surgery in patients with LDH and its effects on prognosis.Objective　To investigate the status of anxiety and depression before microinvasive surgery in patients with LDH and analyze its effects on prognosis.Methods　A total of 140 patients with LDH were enrolled in the Department of Orthopedic Surgery of Central Theater Command General Hospital of the Chinese People's Liberation Army from August 2017 to June 2018.The Self-rating Anxiety Scale（SAS） and the Self-rating Depression Scale（SDS） were used to evaluate the anxiety and depression status of patients before surgery.And patients were divided into anxiety group，non-anxiety group，depression group and non-depression according to the scores.All patients underwent percutaneous transforaminal endoscopic spine surgery and were followed up regularly by telephone appointment.The follow-up deadline was January 2019.The scores of SAS，SDS，and Visual Analogue Scale（VAS） and lumbar spine function scores by Japanese Orthopedic Association（JOA） were compared before and after surgery.The effects of preoperative anxiety and depression on postoperative outcomes were analyzed by the modified MacNab evaluation criteria at the last follow-up.Results　A total of 132 patients were included in the final study，including 51（38.6%） patients in the anxiety group，of which patients with mild，moderate and severe anxiety accounted for 15.9%（21/132），17.4%（23/132） and 5.3%（7/132），respectively，31（23.5%） patients in the depression group，of which patients with mild，moderate and severe depression accounted for 12.1%（16/132），9.1%（12/132），and 2.3%（3/132），respectively.Pearson correlation analysis showed that the preoperative JOA scores were negatively correlated with SAS and SDS scores（P<0.001）．The preoperative VAS scores were positively correlated with SAS and SDS scores（P<0.05）．Compared with preoperative scores，the SAS score was significantly lower in the anxiety group at the last follow-up（P<0.001），and the SDS score was significantly lower in the depression group at the last follow-up（P<0.001）．The VAS scores of the anxiety group and non-anxiety group were lower and the JOA scores were higher at the last follow-up than those before surgery（P<0.05）．The improvement of VAS and JOA scores in non-anxiety group and non-depression group was significantly greater than those in anxiety group and depression group（P<0.05）．The VAS scores of the depression group and non-depression group were lower and the JOA scores were higher at the last follow-up than those before surgery than those before surgery（P<0.05）．At the last follow-up，the excellent rate in the non-depression group was significantly higher than that in the depression group〔93.1%（91/101） vs 74.2%（23/31）〕，and the difference was statistically significant（P=0.004）．While there was no significant difference of excellent rate between the non-anxiety group〔90.1%（73/81）〕 and the anxiety group〔86.3%（44/51）〕（P=0.497）．Conclusion　Some patients with LDH have anxiety and depression before surgery and these adverse psychological states can be significantly improved after percutaneous transforaminal endoscopic spine surgery.However，preoperative anxiety and depression may adversely affect the clinical efficacy，especially in combination with depression.Therefore，it is recommended that the abnormal psychological state should be routinely investigated before surgery and psychological intervention should be carried out for such patients.

Key words: Slipped disk, Intervertebral disc displacement, Percutaneous transforaminal endoscopy, Anxiety, Depression, Prognosis